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Get IN SF 51413 2007-2023

CG-EN EXEMPT EVENT NOTIFICATION State Form 51413 R3 / 07-07 INDIANA GAMING COMMISSION INSTRUCTIONS You must file this application by March 1 or least one 1 week before your first exempt event. Please attach documents. Name of Qualified Organization Street Address City State Zip Code County Name of Contact Person Daytime Telephone Number A qualified organization is not required to obtain a license from The Commission but is required to send notification if the value of all prizes at the event including prizes from pull-tabs punchboards and tip boards does not exceed 1 000 for a single event and not more than 3 000 during a calendar year. filed before the earlier of the following March 1st of each year or one 1 week before the qualified organization holds their first exempt event of the year. The annual written notice to the Commission must provide the following 1 The estimated frequency of the planned exempt events. 2 The location or locations where the qualified organization plans to hold the exempt events. 3 The estimated value of all prizes awarded at each allowable event. Date of Event mm/dd/yyyy Signature of Presiding Officer Location Name / Street Address / City / County/Zip Code print or type Print Name Title Mail Completed Form To Indiana Gaming Commission Charity Gaming Division 101 W* Washington St* East Tower Suite 1600 Indianapolis IN 46204 Page 1 Estimated Prize Payout Date. Please attach documents. Name of Qualified Organization Street Address City State Zip Code County Name of Contact Person Daytime Telephone Number A qualified organization is not required to obtain a license from The Commission but is required to send notification if the value of all prizes at the event including prizes from pull-tabs punchboards and tip boards does not exceed 1 000 for a single event and not more than 3 000 during a calendar year. filed before the earlier of the following March 1st of each year or one 1 week before the qualified organization holds their first exempt event of the year. filed before the earlier of the following March 1st of each year or one 1 week before the qualified organization holds their first exempt event of the year. The annual written notice to the Commission must provide the following 1 The estimated frequency of the planned exempt events. The annual written notice to the Commission must provide the following 1 The estimated frequency of the planned exempt events. 2 The location or locations where the qualified organization plans to hold the exempt events. 3 The estimated value of all prizes awarded at each allowable event. 2 The location or locations where the qualified organization plans to hold the exempt events. 3 The estimated value of all prizes awarded at each allowable event. Date of Event mm/dd/yyyy Signature of Presiding Officer Location Name / Street Address / City / County/Zip Code print or type Print Name Title Mail Completed Form To Indiana Gaming Commission Charity Gaming Division 101 W* Washington St* East Tower Suite 1600 Indianapolis IN 46204 Page 1 Estimated Prize Payout Date. .

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